EFTR in Istanbul: when might full-thickness resection be considered?

What does “full thickness” mean?

An endoscope reaches the treatment area from inside the digestive tract. EFTR removes a piece containing all wall layers. Different techniques manage wall closure differently: some close or isolate the target before cutting; others remove tissue and then close the opening. The appropriate approach depends on location and specialist assessment. Johns Hopkins

A useful consultation question is: “Why would this lesion need EFTR rather than a more superficial technique?”

Sources: [1]

Does a non-lifting polyp mean cancer?

Not necessarily. A lesion may fail to lift because of scarring from previous treatment or sampling. However, deeper cancer invasion must also be considered.

ESGE recommends expert assessment when an apparently endoscopically treatable lesion does not lift. EFTR is a selected option when standard approaches cannot remove a lesion appropriately—not an automatic next step. Its recommendation for these situations is weak and based on low-quality evidence. ESGE guideline

Ask the team to explain what the endoscopic images show, what remains uncertain and whether another opinion would help.

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What alternatives should be discussed?

Depending on the lesion, alternatives may include standard polypectomy, endoscopic mucosal resection (EMR), specialist techniques for scarred tissue, endoscopic submucosal dissection (ESD) or surgery. Lesion size, access, suspected invasion and local expertise affect the choice.

ESGE discusses EFTR particularly for selected small non-lifting lesions, but no single size rule determines eligibility. Suspected deep invasion needs a different treatment discussion. ESGE guideline

Before consenting, ask:

• What finding makes EFTR suitable in my case?

• Could the planned technique change during the procedure?

• What would make you stop or recommend surgery?

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What are the risks?

Potential problems include bleeding, infection, an unintended opening or leak, and incomplete removal. Treatment close to the appendix opening can cause appendicitis. Closure and recovery monitoring are important parts of the procedure, not optional extras. Johns Hopkins

Discuss how complications would be recognised and managed, including access to urgent surgery. Ask for an individual risk explanation rather than relying on a general online success figure.

Sources: [1]

Why does pathology still matter?

The removed tissue must be examined. Depth of invasion, resection margins and other microscopic findings can affect whether further treatment is needed. Full-thickness removal alone cannot establish that an invasive cancer needs no additional care. ESGE guideline

Arrange a named clinician and a date or process for receiving the result. Follow-up colonoscopy depends on the findings and the treating team's plan. NHS patient information

Sources: [2][3]

How should I coordinate an assessment in Istanbul?

For a discussion with Prof. Dr. Barış Yılmaz, ask the coordinator how to provide existing colonoscopy reports, images and pathology securely. A profile link is not confirmation of eligibility, current procedure availability or doctor approval of this article.

Before booking travel, clarify:

• Who will review the records and explain the alternatives?

• What preparation and medication instructions will the treating team provide?

• Who will accompany you after sedation?

• Where will you stay during monitoring, and who will manage follow-up after returning home?

Do not stop blood-thinning or other prescribed medication without individual instructions. Do not assume a fixed discharge or flight date.

What symptoms need urgent attention?

After the procedure, seek urgent medical care for severe abdominal pain, fever, marked abdominal swelling, uncontrolled vomiting or significant rectal bleeding. Follow the discharge instructions; do not wait for a travel coordinator to reply. NHS patient information

Sources: [3]